Dr Y Law

Bidwill Medical Centre

1 Chestnut Crescent

Bidwill

NSW 2770

10.05.2024

Re: Patricia Davies (DOB: 04.10.1965) NBM7818, Review

Dear Dr Law,

Thank you for referring Patricia Davies for a Wentworth Healthcare Extended PTS plan for psychological support for bereavement. I write to provide you with a review at the close of this referral.

Patricia attended her first appointment of this plan on the 20th of November, 2023. She attended monthly appointments over the last six months, and is currently doing well and no longer in need of further support at this time (see update below). Please see previous correspondence for her comprehensive mental health assessment and review from the previous referral.

Initial Presentation

At the time of her initial consultation in March, 2023, Patricia expressed bereavement following the death of her daughter in January. Her daughter was 39 years of age and had lung cancer, however died of emboli and myocardial infarction. Patricia reported that she was struggling emotionally; was “breaking down easily”; had “good and bad days.” She reported withdrawal from socialising and stated “I’d like a reason to wake up in the morning.”

Patricia’s thought form tended to be disorganised and tangential, so taking the history had to be pieced together over a few sessions. However, once she started opening up, Patricia disclosed a long history of extreme domestic violence across several relationships in her life. This had had an impact and she continued to dwell on the aftermath of those traumatic events.

Other stressors included managing the animals on the property with little resources and support, and ongoing relationship issues with her current husband and son who live on the property. Patricia had a fall on the 8th of May, 2023 and fractured her pelvis. This has since healed.

27.03.23 K10 score: 45/50; 23.10.23 K10 score: 39/50

Please see previous correspondence for a comprehensive mental health assessment.

Update

At the commencement of her second plan, Patricia reported continued low mood, with suicidal ideation. She considered that loneliness and ‘not having a life’ were contributing factors, as well as ongoing stressors with her adult children. Her daughter was going through a marriage separation, and her son through a relationship breakdown and distress about being refused access to his children. Additional stressors occurred in February 2024, when her son had a suicidal crisis, requiring police intervention. Patricia had dental surgery in February, 2024 and is awaiting dentures in the public dental system. She has been avoiding socialising until her dentures are in place.

At the time of her review on the 3rd of May, 2024, Patricia stated that she has been much better. Things with her family have improved. Her daughter in QLD had made re-established her husband and they are no longer separating. Her son, had started his own business, which is going well. She has been doing occasional work as a driver for her local farrier, and financial stressors seem more manageable at the moment.

Patricia reported feeling more settled with her husband, and has decided that she now prefers to stay on the property with him (she had been considering a separation). She stated that as she gets older, she is more reluctant to change and prefers to stay in a settled position. Patricia has reconnected with her brother, her only living relative in Australia, and her only sibling. With regards to the bereavement, Patricia feels more accepting of Deanne's death. She stated that she thinks about her every day, but is more at peace with it.

Functioning and Supports

On a carer’s pension (for her son who has mental health issues).

Lives on 5 acre property (rental) with her current husband and son, 2 horses, 2 dogs, a bird and a cat.

Described her current marriage as unsupportive, with a lack of trust.

Patricia has 4 children, who she stated she gets on well with:

Deanne 39 (deceased); Lucinda 35 – lives in QLD; Gary 32; John 25.

Had estranged relationship with her brother, Roland for past 15 years. Recently reconnected.

Medication (as reported by Patricia)

Citalopram (dose not known)

Targin BD for pain (dose not known)

Lyrica 300mg BD for back and nerve pain

MSE

I observed Patricia's emotional wellbeing to be much improved.

Dressed in casual clothes; good attention to hygiene and grooming.

Bright and reactive; smiling and laughing.

Described mood as "I'm doing well now."

Speech - normal rate, tone and volume

Thought form is logical and sequential; no FTD No evidence of alteration in perception.

Good insight about her journey over the past year with grief and loss and showing good judgement in seeking help when needed.

Formulation:

57 year old Caucasian woman of German descent, married and living on rental property, and on a carer’s pension, presenting with low mood and bereavement issues and with a background history of domestic violence. Compounded by chronic back injuries and associated pain and fractured pelvis in May 2023.

Impression

Consider: bereavement.

Significant improvement. No longer requires psychological support.

Plan

Discussed care plan going forward. Patricia does not feel the need for more sessions at this time. Agreed that the referral could be closed. She is aware that she can get back in touch with her GP should she need support at any other time.

Yours sincerely,

Michelle Hookham